Surgical Treatment for Pediatric Scaphoid Nonunion

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Journal of the Korean Society for Surgery of the Hand 2006;11(3):168-173.
Published online September 1, 2006.

Seong-Man Lee, In-Ho Jeon, Tae-Kong Kim, Chang-Wug Oh, Poong-Taek Kim

소아 주상골 불유합의 수술적 치료

이성만, 오창욱, 김태공, 전인호, 김풍택

Abstract

Introduction: Pediatric scaphoid fracture is uncommon injury, but the most common fracture in the carpal bones. Nonunion of pediatric scaphoid fracture is rarely reported, so we reviewed the pediatric scaphoid nonunion and evaluated the surgical outcomes. Material and Methods: Between January 2000 and December 2005, thirteen patients younger than 16 years old underwent operative treatment for scaphoid nonunion and were reviewed retrospectively. The mean age at the time of operation was 13.2 years (range; 11~16 years). Mean interval between initial injury and operation was 6.1 months (range; 3~12 months). The causes of injury were sports activity in ten and punch machine injury in three. Ten patients were treated with open bone graft and internal fixation and three with percutaneous screw fixation. Clinical evaluation based on Cooney index and radiographic evaluation were performed. Result: Nonunion developed following negligence of initial injury in eleven patients and after cast treatment in two. Overall average time for union was 10.5 weeks (range; 8-14 weeks). and it was 9 weeks for percutaneous screw fixation group (n=3) and 11.5 weeks for open bone graft group (n=10) respectively. No major complications such as deep infection or traumatic arthritis developed. According to Cooney index, twelve patients resulted in excellent and one in good. Conclusion: Pediatric scaphoid nonunion is rare but can occur following negligence of initial injury or inadequate cast immobilization. Open bone graft and internal fixation or percutaneous screw fixation can lead successful results in this rare injury.

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